New Voices: Aid-in-dying would worsen health care inequities

Opinion editor's note: This article, part of our New Voices collection, was written by a first-time contributor to Star Tribune Opinion. For more information about our efforts to continually expand the range of views we publish, see startribune.com/opinion/newvoices.

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Over the course of my health care career, I've had the honor to serve thousands of people living with apparent and non-apparent disabilities, including mental health conditions. With access to the proper services and support, these individuals live full, vibrant lives.

As executive director of the Metropolitan Center for Independent Living and former CEO of a licensed behavioral health agency of 17 years, I see daily the power of real health care that advances independent living and upholds quality of life. Unfortunately, I also see the complex problems and inequities in our health care system that disproportionately impact people living with disabilities.

That's why I'm deeply concerned by ongoing efforts to legalize physician-assisted suicide in Minnesota ("Whose decision at death's door," Nov. 12).

This proposed legislation is dangerous for people with disabilities. While the current bill draft may have narrow eligibility requirements, many states where physician-assisted suicide is legal have gradually expanded their laws to include longer-term prognoses and non-terminal illnesses. That should be a pause for concern for us in Minnesota.

Both the National Council on Independent Living and the National Council on Disability (NCD) oppose physician-assisted suicide, and for good reason. A 2019 NCD report stated legalization of physician-assisted suicide perpetuates the "historical and continued devaluation of the lives of people with disabilities by the medical community [and] legislators" by promoting "unequal access to medical care." These inequities are amplified for people with disabilities who are also from Indigenous, racially and ethnically diverse communities.

Is this what we want in Minnesota?

Our state's population is aging rapidly: There are currently more residents over the age of 65 than in our K-12 system. And as we age, more of us naturally develop disabilities that are not life-limiting with the proper support.

Our systems, however, are not well positioned to meet this surge. Demand for services is already far greater than our ability to provide them. Minnesota — and the country as a whole — is facing an urgent, severe crisis due to a shortage of personal care assistants, who assist people with disabilities in remaining independent at home in their daily lives.

To make matters worse, people with disabilities also face a major lack of funding that perpetuates unequal access to care. Many federal and state benefit programs have asset limitations of $2,000 for individuals and $3,000 for couples. These limits have been fixed at the same dollar amounts since 1983, severely reducing care options for people with disabilities and older adults. Imagine if other financial measures were frozen in time for those same 40 years.

It's not surprising, then, that the worry of becoming a financial "burden" has become prevalent. In Oregon, where physician-assisted suicide is legal, a Department of Health study found 52% of patients cited their fear of being a burden to family, friends and caregivers as a primary reason for seeking life-ending medication. Fear of pain and suffering did not even make the top five.

Legalizing physician-assisted suicide would make advising about assisted suicide as a treatment option part of the standard of care all doctors must follow, even if the current proposal would not require them to prescribe the life-ending drugs. Think about what this would mean for people with the non-apparent disability of an ongoing mental health diagnosis? Furthermore, would people feel coerced by a suggestion from a doctor that they could end their life prematurely? Consider also that physician-assisted suicide is significantly cheaper than real, supportive treatments. How will lifesaving care be denied or rationed to those most in need? Physician-assisted suicide legislation poses too many inadvertent risks at a time our state's mental health service providers are in crisis trying to meet current demand for services.

I have a great deal of empathy for patients whose lives have been transformed by a terminal diagnosis and must now live with one or more disabilities. But physician-assisted suicide is not real health care, and it poses too many unintended consequences at a time when there are so many inequities in our care system.

We are at our very best as a society when we work together to advance the ability of people to care for one another. This ought to be our guiding principle as we focus on legislative pursuits that uphold the health and well-being of all Minnesotans.

Jesse Bethke Gomez is executive director of the Metropolitan Center for Independent Living, which is a member of the Alliance for Ethical Healthcare.